Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
Pancreas. 2010 May;39(4):492-7. doi: 10.1097/MPA.0b013e3181bdfc76.
For some procedures, epidural anesthesia and analgesia (EAA) improves clinical outcomes. It is used during pancreatoduodenectomy (PD) to mitigate morbidities and shorten hospitalizations. Although widespread, the use of this practice has not been examined extensively. The objective of this study was to do so.
A retrospective review of 42 patients who underwent PD was performed. Patients with and without EAA were compared. End points included intraoperative blood losses, perioperative fluid requirements, intensive care unit admissions, pain, bowel function, lengths of stay, morbidities, and mortalities.
Eighteen patients received EAA; 24 did not. Patients with EAA who reported less pain on postoperative day 2 (P = 0.03) were more likely to require intensive care unit admissions (P = 0.02) and required more frequent alterations of analgesics (P = 0.0001001). Epidural anesthesia and analgesia was associated with a nonsignificant increase in blood losses and fluid requirements. The groups did not differ in bowel function, lengths of stay, morbidities, or mortalities.
For patients undergoing PD, EAA was not associated with clinical benefits except for a modest reduction in postoperative pain, which was limited to a single day. Therefore, in this study, the clinical benefits of EAA seem underwhelming.
对于某些手术，硬膜外麻醉和镇痛（EAA）可以改善临床结果。它在胰十二指肠切除术（PD）中被用于减轻发病率并缩短住院时间。尽管这种做法已广泛应用，但尚未对此进行广泛研究。本研究旨在对此进行研究。
对 42 例接受 PD 的患者进行了回顾性分析。比较了接受和未接受 EAA 的患者。终点包括术中失血量、围手术期液体需求、重症监护病房入院、疼痛、肠道功能、住院时间、发病率和死亡率。
18 例患者接受了 EAA；24 例未接受。术后第 2 天报告疼痛较轻的 EAA 患者（P = 0.03）更有可能需要入住重症监护病房（P = 0.02），并且需要更频繁地调整镇痛药（P = 0.0001001）。硬膜外麻醉和镇痛与出血量和液体需求的增加无关。两组在肠道功能、住院时间、发病率或死亡率方面没有差异。
对于接受 PD 的患者，EAA 并没有带来临床益处，除了术后疼痛略有减轻外，但仅限于一天。因此，在本研究中，EAA 的临床益处似乎乏善可陈。
